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The Different Stages of Dementia

Contributed by Maura Rhodes, a health journalist based in Montclair, New Jersey, who has written about caregiving throughout all ages and stages of life.

Your dad arrives a half-hour late for dinner at your house, claiming he “made a wrong turn” even though you live only a few miles away. Or your mother drops out of her beloved book club, complaining that the other members’ critiques don’t make sense. Weird, you think, since the group has been reading together for years.

Could the real problem be that your mom can no longer follow the discussion?

You may be right to be concerned: Getting lost along a familiar route or being unable to follow a conversation can be early signs of dementia, an umbrella term for memory loss and cognitive decline associated with damage to brain cells. Alzheimer’s disease is the most common cause of dementia. According to the Centers for Disease Control and Prevention, it’s the fifth leading cause of death among people 65 and older.

Dementia symptoms may be mild at first but they inevitably progress over time. The rate and degree of decline varies from person to person and also depends on the cause of the dementia. Someone who has Alzheimer’s disease, for example, may live with mild symptoms for years.

That’s also often true of someone with vascular dementia, which is caused when brain cells are damaged due to a blood supply blockage, such as from a stroke. Other people with vascular dementia experience sudden changes. Some of the symptoms may be similar to those of Alzheimer’s disease, but they depend on which parts of the brain were deprived of blood. The stages of vascular dementia are typically more distinct than those of Alzheimer’s disease.

Learning that a loved one has been diagnosed with dementia can be devastating. But understanding what’s ahead can help you plan for the care your family member will need.

There are three general stages of dementia caused by Alzheimer’s disease, according to the Alzheimer’s Association: mild, or early-stage; moderate, or middle-stage; and severe, or late-stage. Here’s what you might expect at each stage. Keep in mind that Alzheimer’s disease is a continuum, so the stages may overlap.­­­­­

Mild Alzheimer’s

People who are in the early stage of Alzheimer’s can likely still take care of themselves. They may drive, continue to work and keep up with social activities. They might have memory lapses but think they are normal. Who doesn’t forget where the car is parked once in awhile, for example?

As this stage progresses, however, they might begin to have problems that other people notice and that a doctor could detect during an in-depth medical interview. Some things people might experience at this point:

“Tip of the tongue” instances when the person can’t come up with a familiar word or name

Forgetting the name of someone they were just introduced to

Trouble with familiar tasks such as following a simple recipe or remembering the rules of a game

Forgetting new information they just read

Repeatedly losing things, especially objects that are valuable, such as a wedding ring. Some people reach a point of accusing others of stealing.

Increasing difficulty with organizing and planning

Losing track of routine activities such as meals

Studies suggest that providing early-stage Alzheimer’s patients with guidance in self-managing their symptoms can help them stay active and engaged. The Alzheimer’s Association has several programs for people at this stage.

Moderate Alzheimer’s

For most people, this is the longest stage. It can stretch for many years and bring on personality changes, anger, frustration and perhaps a loss of interest in personal hygiene, as well as increasingly significant memory problems and trouble communicating.

Some people also begin to have physical changes, such as changes in sleep patterns and trouble controlling the bladder or bowels.

Other issues you might see in a person with middle-stage Alzheimer’s:

Inability to recall basic facts about themselves, such as where they were born or went to college, or even where they live now

Becoming moody and withdrawn, especially in social situations. The person may stop participating in beloved activities or hobbies or lose interest in following a favorite sports team.

Confusion about what day it is, where they are or how they got there

Dressing in inappropriate ways — bundling up for a walk on a hot summer day, for instance

Wandering and even getting lost

Suspicion and/or delusional thoughts

Compulsive habits such as hand wringing or tissue shredding

At this stage, a person likely needs some help in the form of in-home nonmedical care or other services, lest they forget to eat or take their medication or pay their bills, or they leave the oven on. The Alzheimer’s Association offers Care Consultations to family members of people with dementia. For loved ones who wander, a tracking system can help.

Severe Alzheimer’s

Once Alzheimer’s becomes severe, a person is considered in the final stage of the disease. Many symptoms will involve physical health. Here’s what you’re likely see:

Inability to carry on a conversation or remember even the most recent experiences

Trouble finding the words to communicate needs or the fact that they’re in pain

The loss of physical abilities such as walking, sitting up and swallowing

Increasing vulnerability to infections, including pneumonia

At this point, someone with Alzheimer’s disease will need 24/7 care, something most people aren’t equipped to provide. A nursing home, memory care facility or fulltime in-home care may be the only way to keep a person with late-stage Alzheimer’s disease safe and comfortable.

Interim HealthCare offers a dementia programthat addresses the needs and concerns of people living with dementia and their families.

A hospice networkcan also be a good solution at this point. Hospice workers know how to care for a person with moderate to late-stage Alzheimer's disease and can improve their quality of life by keeping them as comfortable and relaxed as possible.

There is no cure for dementia, and caring for a loved one with Alzheimer’s disease or another form of dementia is no easy feat. So be sure to get the assistance you need, and focus on helping your loved one stay safe and enjoy life for as long as possible.